Are You a Doctor?
Margaret Kim Peterson
"Are you a doctor?"
I am sitting by my husband's hospital bed in the surgical admission ward, where he is being prepped for surgery to close a severe pressure ulcer on his left ischium, the knob on the pelvis where your weight rests when you sit.
Dwight was eighteen when an illness damaged his spinal cord, rendering him a paraplegic. He is 49 now, and developing the kinds of problems that go along with being a middle-aged cripple (his self-descriptor of choice).
One such problem is pressure ulcers. We thought we'd learned how to manage these, but met our match in this one, which has refused to heal no matter what we've done. Finally Dwight has agreed to surgery, and to the months of post-operative hospitalization that will follow.
So here we are in surgical admissions, talking with the anesthesiologist.
"You're anemic, so you'll need to be transfused before surgery," she tells Dwight. "The surgeon has ordered two units of packed red blood cells."
"What?" Dwight asks, through a fog of preoperative anxiety.
"Packed red blood cells," I say. "As opposed to whole blood."
Packed red blood cells are cells that have been separated from whole blood for transfusion purposes. My knowledge of the distinction seems to startle the anesthesiologist.
"Are you a doctor?" she asks.
"No," I say. Then, feeling that perhaps courtesy requires some explanation, I offer one.
"My first husband died of AIDS. He was transfused a lot."
Now she really looks startled.
"When did he die?"
"Fifteen years ago. The fall of 1995. It was the peak of the AIDS epidemic in the United States. Protease inhibitors were introduced a month or two after his death. It's a different world now."
"Yes." The anesthesiologist looks like she might like to ask more questions, but there's no time. She fades away into the farther reaches of the hospital, and I never see her again.
Classes begin the next day at the college where Dwight teaches New Testament and I teach theology. In my first class I introduce the syllabus, call the roll, invite my students to introduce themselves and then introduce myself to them.
As always, I mention my first husband, and the fact that he died of AIDS. I know that AIDS has touched the lives of many of these young people, and that often they don't feel free to make that fact public. I see it as part of my job to set a counter-example.
"A couple of years later I married the other Dr. Peterson," I continue. "I know, I know. Another guy with something wrong with him."
My students freeze. Are they allowed to respond?
"Sometime we'll have to talk about it," I say with a smile. The room relaxes; the students smile back at me and at one another.
A week later I get an email from a friend, inquiring about Dwight and the progress of his recovery. I write back, saying that the surgical site is healing, but the medical picture as a whole is complex. "The IV antibiotics are causing a lot of GI problems, his protein levels are really low, so is (or was) his hemoglobin (they gave him two units of packed red blood cells before surgery, and another two on Saturday), his electrolytes are out of balance because of everything else, etc."
My friend writes back: "You sound like a doctor!"
Another week goes by. Dwight is transferred to a long-term acute care hospital. His feet are swollen, and so his surgeon has recommended that we bring in the pressure boots Dwight wears at home. A nurse asks what we've been taught concerning their use. We haven't been taught anything, we say, but at home Dwight wears them a few hours a day.
"When he's in the hospital, he should wear them all the time," the nurse says authoritatively. "We'll put them on and check his feet four times a day."
Three days later I happen to glance at the boots. Idly, I ask Dwight, "When was the last time they checked your feet?"
"No one has checked my feet," he says.
My heart sinks. I unzip the boots.
Dwight's feet are covered in blisters. I feel a flicker of anger, and another of fear. Why didn't Dwight make sure someone checked his feet? Why didn't I? How bad is the damage?
Within minutes there are two nurses in the room, silent, shocked, removing the boots, charting the blisters, while I vent between clenched teeth to Dwight about all the doctors who have rounded on him in the past few days, not one of whom bothered to notice the boots or check his feet.
The doctors make a convenient target. It's easier to be angry with doctors I've never met than with nurses I know, or with Dwight, or with myself. And it's easier to be angry with these unknown doctors than to open myself to how overwhelmed I feel. I don't like being in the midst of a medical crisis; I don't like not knowing whether Dwight will ever get well; I don't like feeling that it's up to me to keep track of all the details, and that I'm failing.
I've learned to talk "like a doctor" precisely because it has helped me keep track of details that can make the difference between health and illness, even life and death. But right now, looking at those blisters on Dwight's feet, all I want is for someone else to be in charge, someone who actually is a doctor--someone whose mastery of medical language is complete, who never lets any detail slip through the cracks, who prevents all problems before they happen. Isn't this what a doctor is supposed to do?
For the moment I conveniently forget that no doctor, no matter how good, can keep the dangers and vulnerabilities of life in the body at bay forever. Right now, I'm just angry.
I'm also late to pick up our ten-year-old son from school. Before I leave, I take a deep breath, put on my best professional non-reactivity and talk with a hospital administrator about what has happened, and what needs to change.
Am I a doctor?
No, I'm not a doctor.
About the author:
Margaret Kim Peterson holds a PhD in theology and ethics from Duke University and teaches at Eastern University in St. Davids, Pennsylvania. She is currently a student in the master's program in marriage and family therapy at La Salle University in Philadelphia, and in the fall will begin an internship in integrated behavioral health at a Federally Qualified Health Center (FHQC) in North Philadelphia. "Dwight was in the hospital from January to May. He continues to recover, and in the fall will return to teaching. I'm on sabbatical!"